Keira Barr, MD: [00:03:43] Thank you for having me.

Keira Barr, MD: [00:04:14] Yeah, so this is probably true for a lot of people, like when your own health takes a no side, you start looking at things very differently. And so for me, being a skin cancer and melanoma specialist, when I was practicing dermatology, it was really eye-opening when I had to diagnose myself with melanoma. So starting in my childhood, you know, I was made fun of for two birthmarks that were on my skin. And I learned at a very young age that my skin could be a source of shame and anxiety. And I learned really quickly that if I got a tan I could mask those marks. No one could see them. Unfortunately, I didn’t know then what I know now, is that getting lots of tans and sunburns over the course of a lifetime yields a lot of sun damage, which ultimately, in my case, wound up with a diagnosis of melanoma.

Keira Barr, MD: [00:05:03] And up until that point, I thought I was doing everything right. I was exercising. In fact, I was running ultramarathons. I was going to do, I was going to be the best at everything. I was going to run the furthest race, juggle my academic career, my family, and all the things. And that diagnosis showed me that what I was doing was not serving me at all. And that’s kind of the tip of the iceberg because then I started to have gut issues and hormonal issues and all the things, and going to my traditionally trained colleagues who just wanted to offer me prescriptions. And things that just weren’t working really led me to functional medicine, integrative medicine, and really taking a step back and exploring a whole new world.

Keira Barr, MD: [00:05:45] All the things that I had been told didn’t make a difference in health like diet and other things, I realized, wow, it really does. And so it really reframed how I look at skin health, how I look at overall health and well-being and really connecting the dots, especially in my own situation, the impact of stress and physical stress, emotional stress, mental stress on our overall health and wellbeing, and skin cancer in particular. So that’s kind of when your mess becomes your mission. I thought, okay, I’m a physician. I’ve been at this for over 20 years and if I don’t have a clue how my body’s working and how my body is responding how is the average woman supposed to understand all this stuff? So again, I just wanted to pay it forward and share what I’ve learned.

Keira Barr, MD: [00:06:48] Yeah. It was awful. But so here’s the thing. Over the course of a decade, I was having my moles… I always tell everyone to get naked, party in your birthday suit, check your suit every single month on the date of your birthday for any uninvited guests. So really getting in the habit of checking your skin or anything growing, changing, itching, and breathing. So I was in that habit so thankfully and obviously, I’m a skincare expert so I knew what to look for, but I was constantly checking my skin. And over the course of a decade leading up to my diagnosis, my moles were changing and I was having biopsies every couple of months. But at that time I was just like, well, that’s just what we do in dermatology. Something’s changing. You cut it out and you don’t necessarily think about the underlying pathophysiology, the root cause of why these things are happening.

Keira Barr, MD: [00:07:36] And so I was doing my routine skin check and I saw this spot on my arm and I was like, wait a second, that’s different. And at the time, not only was… I’m clinical dermatology, my subspecialty is dermatopathology. So then I had to see what my skin looked like underneath the microscope and confirm the fact that what I was seeing on the surface was in fact really atypical, underneath the surface. And it was horrifying. It was horrifying. And I felt crappy, because, that’s, to say the least. Practicing what I’m preaching, here I am telling people to do all these things and then I basically faced the very diagnosis that I’m treating. Thankfully, because I was diligent about checking my skin, I was able to catch it early. But just understanding that everything that I thought was right up until that point and understanding that I was so, so wrong. It rocked my world a bit.

Keira Barr, MD: [00:09:04] Yes. So many things. Oh my gosh. And actually, everything up to that point that I learned is the reason why I wrote my book, The Skin Whisperer. So our skin and body are sending us messages all the time. And mine was shouting at me and I was completely deaf to it. So the goal is to hear these messages, to see these messages that your body sending you when they’re just a whisper. So what aren’t we talking about? We aren’t talking about how we nourish ourselves on every single level – food, our relationships, our careers, our sleep, our movement, all of that matters, and how your body deals with stress. And so when we talk about skin cancer, we talk about something called the exposome. It’s the environment in which your body is exposed to and it’s your total environment.

Keira Barr, MD: [00:09:56] So we’re talking about external stresses like UV radiation and air pollution. We’re talking about the food you eat. We’re talking about your sleep and your exercise. We’re talking about emotional stress. All of that plays a role in how your immune system functions, how it responds to stress, how it repairs itself or it doesn’t have the ability to repair itself. So these are all the things that I discovered. And so it basically had an overhaul in pretty much every facet of my life.

Keira Barr, MD: [00:11:15] Yes. So here’s the thing. All is not lost. Skin cancer is the most prevalent cancer worldwide. It’s also the most preventable. The problem is it’s the most ignored. So what can we do? You mentioned some of the top things from the outside in. Sun protection, sun protection, sun protection every single day, rain or shine, because 80 percent of UV rays get through the clouds. So it doesn’t matter what season it is, doesn’t matter the weather outside, you’re still getting exposure and 90 percent of visible signs of aging are from UV exposure. So if I can appeal to your vanity, if you want to stay youthful and have that glowing appearance, you want to protect yourself from the sun on a daily basis.

Keira Barr, MD: [00:11:54] So from the outside in, wearing a broad-brimmed hat, sunglasses, sunscreen, SPF 30 or above, and I am a big fan of the mineral-based sunscreen, zinc oxide, or titanium dioxide because they’re tolerated by most people, they have been recognized as generally safe and effective. There’s a controversy over ingredients. That’s a whole other conversation. And then clothing. So the Skin Cancer Foundation, well, they, and I believe this as well, clothing is your number one line of defense because then you don’t have to put any chemicals on your body. You can just shield yourself from the sun, but you really have to build your resilience from the inside out first. And so the things that I find that move the needle the most for people and this is not just for skin cancer, but overall health and well-being is really focusing on your sleep and your stress.

Keira Barr, MD: [00:12:44] So we need to sleep. But how can we make it better quality sleep? Because especially for your skin, it’s when your skin rejuvenates repairs, rebalances hydration, and it’s also when your hormone melatonin is generated. So melatonin is one of the most potent antioxidants that your body naturally produces for skin cancer specifically or skin damage specifically. Melatonin is incredibly important for DNA repair. In fact, melatonin is so incredibly important to skin rejuvenation repair that they are using melatonin as adjuvant therapy for skin cancer treatment. And your body naturally produces that every single night. So really optimizing your sleep is important.

Keira Barr, MD: [00:13:33] And the other thing is stress. We all have stress. We’re still living in a pandemic even though in some parts of the world, especially in the States, we are emerging out of it. But friends in Canada, they’re in full lockdown, right? So we’re constantly under this uncertainty. We can’t get rid of stress. And it’s not that the problem is that stress exists. It’s our response to it. So learning how to have tools in your toolkit to help modulate that stress response so it can work for you rather than against you because chronic stress suppresses your immune system. And when your immune system is suppressed, that is when chronic issues, disease happens, including skin cancer.

1. Keira Barr, MD: [00:15:05] Yeah, I was just laughing because I’m a New Yorker. I was born and raised in New York and my parents still live there. And when I go, I feel like my energy just shifts. I live on the West Coast now and definitely, I live on an island. I’m not saying I’m not stressed, but when I go to New York, it is from five to a hundred. So I think just a baseline living in a big city, it’s challenging. You may not be as aware how much things are impacting you. Your nervous system is kind of already at a heightened state of alert.

Keira Barr, MD: [00:15:57] Yeah, for sure. And that’s why we love, that’s why people love the city because there is that energy. But I think it’s just being mindful of how that energy affects you. And when you ask me what have I found to be the most effective, and I’m not discounting also nutrition and exercise because movement and nutrition are incredibly important. When it comes to movement, again, we can do too much. So moving in a way that feels good for your body, for me, I was running ultramarathons, that didn’t serve me. There are other people where their body can handle it. It’s knowing what your body can handle and how you feel because over-exercising can suppress the immune system as well.

Keira Barr, MD: [00:16:38] We know that for endurance athletes spending time outside increase your exposure again, putting you at risk. So just understanding what your body needs and balancing your risk-benefit ratio. So if you’re an endurance athlete, then getting out earlier in the day or later in the evening is going to be important to minimize how much intensity of UV exposure you’re getting. And when it comes to nutrition, there are amazing studies. And I have a lot of this in my book as well. Certain spices have been shown to have anti-carcinogenic photoprotective sun-protective benefits. There’s a lot of foods that can be… Food is medicine but there is no one thing. So we like to put it all… It’s a holistic approach to our health, a holistic approach to skincare.

Keira Barr, MD: [00:17:29] But I do think that sleep and stress are at the top simply because, as you noted, most of us put that on the back burner. We’ll get to it later. We’ll get to it later. The problem is we never get to it. And upwards of 80 percent of all doctor’s visits are for stress-related ailments. Skin issues are no exception. In fact, the number one reason why people go to the doctor is for skin issues. So stress and skin – hugely connected. Our skin actually has the same mechanism. We always talk about the stress response, the hypothalamic-pituitary-adrenal axis, the sympathetic adrenal medullary axis. Your skin actually has the exact same axes in it and can reduce the stress hormones within it.

Keira Barr, MD: [00:18:14] So not only is it a perceiver of the stress response from your brain sending a signal to your adrenals to pump out those stress hormones and the inflammatory cascade that follows suit, your skin can produce the exact same hormones. So it receives, it perceives, and produces. So your skin is an incredible organ, but it’s also incredibly impacted by the effects of stress. So to your question, what have I found helpful? I think number one is awareness, it’s really being able to tune into your body. Most of us are disconnected. Our mind is disconnected from our body. We’re go, go, go, go. Do, do, do. And it’s just taking a pause for a minute to be like, how do I feel right now? Is this the energy that I want to feel? What do I need? What would feel like love right now for my body? So awareness is number one.

Keira Barr, MD: [00:19:11] The second biggest thing is literally breathing, especially for busy New Yorkers, busy physicians, busy people y don’t need one more thing to put on your to-do list, but we’re all breathing. We do it automatically. So it’s a matter of, again, awareness, paying attention to how we are breathing. Are we breathing rapid? You know, are we breathing shallow or breathing in or chest or belly? And really just tuning into that because when we can take a pause and slow things down and take a deep breath, we can go from that fight or flight mode and activate that rest and digest mode. We can turn on that parasympathetic response and literally help our body relax and bring the inflammatory milieu in our body down.

Keira Barr, MD: [00:21:06] A hundred percent. And that’s what I help women get. It’s connecting those dots. So because of my lens through skin, even though I’m not actively practicing dermatology right now, I really have shifted the focus of my work to help people connect the dots for themselves, to help manage the stress. What I’m finding… You know I was spending a lot of my time supporting women in menopause with bioidentical hormones. They come to me thinking that they want their skin to look better, but really they want to feel better. And so I had really spent a lot of time studying bioidentical hormones and such and it all, every single conversation kept coming back to I’m not sleeping and I’m stressed out. We’d look at their hormone levels. They’re fine. I couldn’t give them any more.

Keira Barr, MD: [00:21:56] And so what I found is when I could teach them how to breathe and meditate or do some other mind-body practices, all of a sudden they were sleeping through the night. All of a sudden they felt more at ease and more comfortable and everything else fell into place. So I think that everything is connected. And even eating. Nutrition is so powerful and important. And it’s so interesting that fasting, I mean, there’s literature on fasting in skin cancer. So what we eat and what we don’t eat are just as important and how we eat. And again, I wrote about that in the book as well, because these are lessons I had to learn for myself.

Keira Barr, MD: [00:22:39] You know, there’s so much dogma about, eat this, don’t eat this. And you have to tune into what your body needs. Your diet is going to be very different from mine. And especially stress and the havoc that it wrecks on our digestive system. Our body is thinking it needs to get out of whatever harms way. Digestion is just not on the top priority list. It’s going to shut down. And then we have indigestion, bloating, and constipation and dysbiosis, and all the things which then can show up on your skin in a host of ways, because we know that there’s that gut-skin connection. And so I always like to teach people that they can use their skin as their greatest asset.

Keira Barr, MD: [00:23:25] I think most people look in the mirror and they’re like, oh, I’m breaking out, or I have this rash or this wrinkle. And they just use it as a license to beat themselves up, especially women. I think that it’s really easy and the beauty industry is all over them on that. It’s a five hundred billion dollar plus industry. They’ve got the cream and the serum and the salve and the procedure to help with it. But here’s the thing. I don’t have anything against any of those products. They can be very useful. But when you see that your hair is thinning, if you see the lateral third of your eyebrows have fallen out. If you see that you have dark circles under your eyes or you are breaking out rather than beating yourself up to try and cover it up or there’s something wrong with you, use that information to your advantage. That is your skin. That’s your body’s way of saying, hey, I need your support, I need your help right now. And you might not know exactly what that is.

Keira Barr, MD: [00:24:23] You might have to go see the professional but it gives you the opportunity to pause and be like what is happening in my world? What’s been happening the last couple of days, last couple of weeks? How am I feeling? Check back in and be like, oh yeah. There’s something, you know big deadline at work or got into it with my significant other. The kids are really… Homeschooling them is just… I’m at my wit’s end and then I’ve been comfort eating and eating foods that aren’t serving me very well. And it’s this vicious cycle and I’m not sleeping because the only time I have to myself is when the kids go to bed and I’m on my device for, whatever. So it’s just it all adds up.

Keira Barr, MD: [00:25:56] So acne. Food, diet for sure. Because for some people, dairy can be a big culprit and sugar. Those are the big ones because they turn on insulin growth factor one receptor, which directly stimulates your oil glands. So I’d be looking at gut health for acne and stress. So I contributed to a chapter in the Integrated Book of Dermatology – Stress And Acne, and not only how stress can trigger acne and the inflammatory cascade, but also how it’s impacting the individual. Eighty-five percent of the population will have been impacted by acne and studies have shown that it doesn’t matter how mild the physician might think it is when it’s on your skin. It could be catastrophic. So we really need to deal with how it’s impacting how you feel in your skin. So those would be the two things like stress and diet for acne.

Keira Barr, MD: [00:26:56] Oh again. Are you sleeping… How are you sleeping? Because we always think of hydration, but just drinking a ton of water isn’t necessarily directly correlated to how hydrated your skin is. But again, sleep and stress. And the biggest reason is skin rejuvenates and repairs at night, hydration, rebalance. If you’re not sleeping, then your other hormones are out of whack. And we may be stress eating because we’re tired and then inflammation and so a big cascade. Sleep and stress for dry, dehydrated skin.

Keira Barr, MD: [00:27:35] Yeah. So again, so helpful. So important for so many reasons. Omega-3 fatty acids, but especially for the anti-inflammatory response that it has throughout the body, but also very helpful for our skin.

Keira Barr, MD: [00:27:53] Okay, so again, sleep.

Keira Barr, MD: [00:28:00] All day long. Beauty sleep is real. Beauty sleep is real, and liver health too. What are you eating? Are there any food sensitivities? Because sometimes we only think about the allergic shiners. Food sensitivities, sleep. Those are big ones and liver health. So how is your body dealing with all of this and how are you detoxifying. So yeah, gut, liver health.

Keira Barr, MD: [00:28:30] That’s a challenging one. So I think there’s definitely some that could be some genetic predispositions and things like that. And people will talk about lymphatic drainage and dry brushing, and rubbing my thighs, the paddle, and all the things. That’s a challenging one. So I would say, I think just movement, circulation, but also looking at…  We all have cellulite. I mean, you look at babies, they’ve got cellulite.

Keira Barr, MD: [00:29:03] Everyone has it.

Keira Barr, MD: [00:29:23] I’ve kind of stepped away from prescribing bioidentical hormones. I think there are so many benefits from it. But what I found especially was, the focus of conversation was how are you sleeping and your stress. So hot flashes, some of the biggest triggers – yes, it’s a decrease in estrogen and fluctuating hormone levels. But what are the things that caused your hormones to drop even further? Stress. It’s always stress. What can stress the body? We know for hot flushes, in particular, alcohol can worsen hot flashes. Sugar intake. So blood sugar dysregulation can be a stress on the body as well and worsen hot flashes. So I really look at diet, alcohol included in that. Sleep. When we’re not sleeping. That can create challenges with your cortisol.

Keira Barr, MD: [00:30:17] So our circadian rhythm, the natural rhythm that our body follows… You know cortisol is supposed to go down at night and back up in the morning. But when our sleep pattern is off, if we’re staying up late, eating late, on our devices that cortisol curve can get flipped or can get really irregular. And so then we’re kind of wired and tired. So really looking at sleep and I keep coming back to sleep. It affects your mood and your ability to deal with any stress that comes your way so that cortisol can wreak havoc on your skin. It breaks down the collagen. So for that youthful… The best anti-aging strategy is sleep.

Keira Barr, MD: [00:31:04] Right? Happiness from within. And all of these things we’re talking about, I fully acknowledge they are simple. They are not easy. This is why Big Pharma is such a big industry because we all want the quick fix. We all want the magic pill and sometimes we need it. I am not pooh-poohing. I am an allopathically trained physician. One hundred percent fan of Western medicine. But there is a bridge that we need to create because the pill can only do so much. It’s all the other lifestyles, how we truly nourish ourselves. We have to do all the things. We start with one thing. You start with the one thing and then you build on that. So it doesn’t feel so overwhelming because we don’t want to make it stressful.

Keira Barr, MD: [00:32:14] Yeah, for sure.

Keira Barr, MD: [00:33:00] It is hard. And again we teach what we need to learn the most. I know full on what it’s like not to feel comfortable in my skin. And I’d be lying if I said that I always feel confident in my skin. I have plenty of days when I don’t, but that’s where self-compassion really comes into play. And I didn’t even know what self-compassion was until recently. And I think it’s really just giving yourself permission to be like, listen. There is nothing wrong with me. Everything that I’m seeing, if nothing else, start from a neutral place. I think it’s impossible to go from I hate myself to I love myself. I think that’s a huge leap. But when you look in the mirror, can you at least find something that you have in mind that you have an appreciation for?

Keira Barr, MD: [00:33:51] So you’ve got cellulite on your thighs, but are you able to stand up or even if you’re not, if you’re in a wheelchair, what have those legs been able to serve you? What has been their function? Can we appreciate their function and come from just a place of gratitude and appreciation, I think is always the place to start. There’s always something that we can appreciate about ourselves, right? Like our eyelashes. You know, they may not be as lush and you might feel like you need falsies, but those eyelashes are protecting your eyes from debris. They serve a function. So to start from a place of appreciation and gratitude is always where I start.

Keira Barr, MD: [00:35:33] It really does. And the same thing at night. So it’s usually… As soon as I get up and then before I fall asleep, just three things, three things that you’re grateful for, but especially when it comes to our persona, our outer appearance and feeling comfortable and confident in our skin, having an appreciation for the body parts is one place to start. So, gratitude in the morning and in the evening, I think, especially because as good intention as we have to keep that good feeling going, things will have come up throughout the day that will derail us. So if we can end our day on a high note by having gratitude, we’ll sleep better. We’ll feel more relaxed to get a good night’s sleep, which we know is so important for our skin in general.

Keira Barr, MD: [00:36:19] Oh, I know what I was going to say. So having appreciation. But again, when you see something in the mirror that you don’t think should be there or is a blemish or what have you, just keep in mind that that’s an opportunity, right? It’s not something to be berated. It’s an opportunity to understand what your body needs. What kind of tender loving care is it asking of you to give it? Because your skin, when you’re living well, moving well, loving well, all of those things, those nourishing activities that we do, your skin will glow.

Keira Barr, MD: [00:36:53] It won’t be able to help itself. It’s going to be your biggest cheerleader, your biggest advocate. But when you’re not doing those things, it is the crappiest confidant. It will tell all the secrets. It’ll gossip about you. But in many ways, that’s not a bad thing either. It’s the best kind of gossip you could ever imagine because you could do something about it. So my I guess my message is this is empowering. Society would like to disempower us. I am aging. I am not Benjamin Button. I’m not aging in reverse. I think I hate the term anti-aging because I can’t. It’s impossible.

Keira Barr, MD: [00:37:39] Exactly. I mean, for so many reasons, we are so fortunate to live this life and every day is a gift. It is not guaranteed. And so if I can age, I want to celebrate that. So we can celebrate aging, we brace-aging but we can minimize the inflamm-aging so that we can age well,  age healthfully. So when you see this stuff on your face, it’s not something that instantaneously you need to go out and buy, purchase something to cover it up. It’s like you said, be empowered, learn more about yourself. What do you need right now? What would feel like love right now for you?

Keira Barr, MD: [00:39:08] I think the cosmetic industry, the beauty industry are so lucrative for a reason. And I am not anti-procedures or anything. It’s a matter of the intentionality behind it. It’s your why. If you feel so good, you feel great. You feel confident and you want the outside to mirror this inside, go for it. Your return on investment will be beyond. The challenge is when we operate from the space of, okay, I need to do X, Y and Z procedure, get filler, get Botox so then I will feel more beautiful. I will feel more worthy, I will feel more confident. You will never get the outcome you’re desiring and you’ll keep searching for that next thing. And you will spend all this money and so you’re not going to get that return on investment. And so that’s, I guess, the space that I would love to support women to help them know that they’re already worthy. They don’t need to do any of these things. And it may be hard to believe, but you can get there. It is going to be hard work, but it’s so worth it so that when you want to do those things you get your money’s worth.

Keira Barr, MD: [00:40:57] There’s no denying it. Like getting your hair blowout. I think that’s Drybar’s tagline or something. We don’t sell blowouts, we sell confidence and in many ways it’s true. Sometimes starting with the outside, if you need a little zhooshing to be the catalyst for you to take better care of yourself, so be it. Do whatever you need to do to be able to take better care of yourself, to show yourself some love. It has to start someplace. Because when we don’t, when we don’t value ourselves and we don’t come from a place of love, we wind up with skin cancer and hormonal issues, having multiple surgeries, and just kind of hitting rock bottom. And it’s not a great place to be. And I get it. Some of us, need to go there. Otherwise, without the shit, the shift won’t happen. Yeah, but hopefully it’s not as deep a pile, if anything, that we talk about today can help ease that transition a little bit.

Keira Barr, MD: [00:42:18] So I like to keep it simple, partly because I am the least compliant person. So it’s got to be simple otherwise I’m not doing it. So skincare routine can be really simple. So a gentle cleanser. So your morning routine could be three steps – a gentle cleanser and antioxidant serum because… Looking at my window… Because even if you work indoors… So my office is in front of a window, I’m in front of a screen. UVA rays penetrate your window glass. So if you’re indoors and UV rays don’t vary throughout the area, whereas UVB rays do. So you’re getting exposure every day, all day long even if you’re indoors. And that causes great oxidative stress and DNA damage.

Keira Barr, MD: [00:43:02] So an antioxidant, vitamin C, E, resveratrol, there’s lots of..but at minimum, vitamin C and E are great antioxidants to have in your serum and then SPF every single day, whether it’s in your tinted moisturizer, would be great because then service your foundation. And tinted having iron oxides will also protect from blue light, the high energy visible light that we get from our devices, which we know can cause pigmentation and also has been shown to have an effect on collagen and elastin.

Keira Barr, MD: [00:43:34] So washing your face and antioxidant serum and SPF 30 plus every single day and be on your way. Evening, gentle cleanser, you can use your antioxidant serum again and then a topical product like a retinoid if you can tolerate it, for increasing skin cell turnover, helping with repair. So Retin-A is a prescription strength. It comes in different strains. But your retinol, retinoids, retinol hydroxy you can get over the counter. And if you can’t tolerate the top retinoids because they can cause dryness, irritation, sensitivity, they do make you more sensitive to the sun which is why we only use them at night, and then we wear some protection in the daytime. But something like bakuchiol is a nice alternative because the studies were done, retinol and bakuchiol head to head and they showed equal efficacy. If not bakuchiol actually was a little bit more efficacious and it didn’t create the same skin irritation. And it can be used in pregnancy, whereas topicals retinoids. Well, when taken by mouth, Vitamin A derivatives are a category X, so they’re not safe. Used topically, we use so little. It’s probably fine, but we always say don’t do it whereas bakuchiol is thought to be safe to use.

Keira Barr, MD: [00:45:16] We’re still learning about the microbiome everywhere in the body, but your skin is your barrier, your ultimate barrier between the inside and outside world. So maintaining that barrier is really important. So moisturizing the skin, humectants draw moisture into the skin. Occlusive agents seal that moisture in. And so depending on the time of year, you may need a product that has humectants properties as well as occlusive. So occlusive properties can be like coconut oil, shea butter, petroleum, which I’m not a big fan of, but castor oil is an alternative. A humectant is drawing moisture to the skin, like glycerin, for instance.

Keira Barr, MD: [00:45:58] And the important thing, too, is the skin microbiome, depending on what we’re using on our skin, different personal care products, soaps, cleansers, it can shift the microbiome. So if you’re noticing more skin irritation, inflammation, you know, it all, it’s about awareness, looking at the products that you’re using and maybe shifting them to no fragrance or other products that can support the skin. So we’re learning more about even the sun. So there are certain bacterial strains on the skin that are thought to be sun protective.

Keira Barr, MD: [00:47:12] Less is more. I think the 21-step skincare… More power to you if you can do it again. Again, I’m not the compliance. I’m a little lazy. The simpler the better. And I don’t think… Sometimes less is more. You really need to just gently cleanse the skin because we know that especially at the end of the day if you’re only going to wash your face once, do it at night because we know that air pollution can settle on the skin, the aromatic hydrocarbons can settle on the skin and contribute to hyperpigmentation and oxidative stress. So you want to cleanse all that debris off and then help repair, rejuvenate and repair.

Keira Barr, MD: [00:47:57] So that’s where the antioxidants… Your skin has its natural antioxidant system, but it gets used because we’re constantly exposed to stressors all day long. So kind of replenishing that with a topical formulation and then helping the skin rejuvenate and repair so your skin cells turn over every 30 days or so. But as we get older, that cycle slows down. So you might have that dull, sallow appearance. So using a product like a topical retinoid to help improve the skin cell turnover so the young, healthy cells can come to the surface is important. So you don’t need a lot.

Keira Barr, MD: [00:49:16] Yeah, so that’s a challenging one because hormonal issues can happen at any time, starting in our teens or twenties, but especially for women wondering if they’re heading into the menopausal phase of life. So menopause can really be broken down into three phases like pre or perimenopausal, so the time frame leading up to menopause. Menopause is actually a day. It’s a milestone. It’s 12 months after your last menstrual period. You are now officially a menopausal woman and everything after that is postmenopausal. So women spend about a third of their lives in a hormone-deficient state. And that can start for many women in their mid to late thirties. And it starts with the hormone progesterone. It’s the first hormone that really starts to diminish first.

Keira Barr, MD: [00:50:05] And so what women may notice from a symptom standpoint is progesterone is thought to be the great relaxing or the great calming hormone. So they might notice they’re feeling more anxious. All of a sudden they’re feeling more anxious than they have before. What’s going on? They’re not sleeping as well. And then when it comes to our skin and our hair, progesterone plays an important role in regulating some hair issues. So testosterone is that androgen, that male hormone, and testosterone is converted into a more potent form called dihydrotestosterone. And that conversion happens through an enzyme called 5-alpha reductase.

Keira Barr, MD: [00:50:43] Well will progesterone normally is responsible for blocking that hormone, so kind of modulating that conversion of testosterone to its more potent form. Why that’s important, especially in our mid to late 30s, 40s, and on up? On the scalp this more potent form of testosterone, dihydrotestosterone affects the hair follicles by what we call folliclular miniaturization. It causes the hair follicles to shrink. So the caliber of the hair coming out is much thinner, much finer. And so how that looks clinically is male pattern hair loss or female pattern hair loss. Women may notice that their part has become wider, their hair looks more thin and fine. They almost look like they’re going bald.

Keira Barr, MD: [00:51:31] On the face it has the exact opposite effect. Dihydrotestosterone can stimulate those hair follicles so women may notice, oh my God, I’m going bald, I’m growing a beard. WTF!. So now this can happen also in PCOS and other situations that aren’t necessarily menopausal. It’s a hormonal imbalance. But if you’re in your mid to late thirties and you’re noticing a shift, so it’s a clue. We know that estrogen also plays a significant role in our skin and hair health. So, again, women may notice the biggest causes of hair loss in menopausal women is chronic telogen effluvium. And I’ll share what that is in a second. Female pattern hair loss and trauma to the hair through chemical or physical processes. So if you straighten your hair, chemically treat your hair.

Keira Barr, MD: [00:52:23] Chronic telogen effluvium brings us back to stress. So your hair grows in three phases. A growing phase, a resting phase, a falling out phase. The falling out phase telogen. So chronic telogen effluvium means the hair is just chronically shifted into that falling out phase. And so we are in a pandemic, life stresses, things like that, that can contribute and also stress on the body as hormones are shifting. Estrogen plays a significant role in hair growth because it prolongs that growth phase. And this is why when we’re pregnant and estrogen levels are increasing, our hair becomes more lush and full.

Keira Barr, MD: [00:53:04] When we give birth, hormone levels plummet and a lot of women will notice their hair is shedding. That’s why. A precipitous drop in your estrogen levels. The same thing starts to happen in menopause. So as levels are starting to go down, progesterone is going down first. So there’s relative estrogen dominance, but estrogen levels are still declining. So the hair’s being in that growing phase that’s diminishing, so women may notice that their hair is either shedding a little bit more or it’s just not as full or as thick. Estrogen also plays a significant role in skin hydration. So it’s responsible for creating hyaluronic acid. What women are paying to have injected into their face, estrogen is creating naturally.

Keira Barr, MD: [00:53:51] So women may notice that their skin is more dry, more sallow, and not just on their face, but on their body and especially their vaginal area. So that’s where sex can become a little bit more uncomfortable all of a sudden. They weren’t needing lube before. Now they need lube. The same thing, estrogen plays a significant role in college formation so noticing more fine lines and wrinkles as they’re getting older, as the hormone levels are dropping. So I know that’s a lot, but our sex hormones play a significant role in our skin and hair health, which is why people are like why would a dermatologist get into menopause? It’s because it’s the first… All these signs that you start to see actually are due to hormonal changes. Again, you can use your skin as this amazing reflection of what’s happening in your body.

Keira Barr, MD: [00:54:53] Yeah, so it really is… I will preface it by saying every woman is different and it really depends on what her own personal thoughts about hormone replacement therapy are, what her personal history is, what her medical history is if it’s even appropriate for her. So even though I had been prescribing, I’ve kind of stepped away from that and just would refer to my colleagues. But again, it really starts with lifestyle because hot flashes, which is one of the big symptoms and one of the most bothersome symptoms associated with menopause, isn’t just because estrogen is decreasing. It’s blood sugar regulation, it’s stress and it’s other factors. So I always take a step back and look at lifestyle factors and really build a strong foundation of inner resilience.

Keira Barr, MD: [00:55:38] I collaborate with a functional nutritionist and work closely with her to help see where we can fill in the gaps for these women because it really is about building a strong foundation. Yes, some women may want hormones. Some women may need hormones in the long term. But if you just put hormones into the mix and they’re not, their gut health is off or their liver and their detoxification, how they metabolize the estrogen is not fully functioning, they’re not going to feel that well if you just give them the hormone. So we really have to take a step back, a more global approach and look at nutrition and look at sleep, and stress is a big one. So that’s always where I start.

Keira Barr, MD: [00:56:39] That’s just a hard one. There’s so much I want to say. But I think it touches on when looking in the mirror, finding that one thing that you can appreciate and asking yourself the question like what would feel like love right now so we can get to the place of loving ourselves, which may take some time, but that’s where I would start.

Keira Barr, MD: [00:57:03] Yeah, so my website, drkeirabarr.com, and I’m starting to get a little bit more social on Instagram @drkeirabarr. So those are the best places.

Keira Barr, MD: [00:57:21] Thank you.